Faded Memories: Living With Dementia

At first, Lenny thought it was just old-age forgetfulness — not being able to recall on which night the Giants played, or remember his granddaughter’s city address. None of his family suspected anything was out of the ordinary — the then-76-year-old Korean War veteran still drove with a good-standing license and regularly kept in touch with friends who came to visit his three-story home in Weehawken, New Jersey. When Lenny’s nephew Carl came to visit a year later, the house seemed abandoned, with blinds taped over the windows and a neglected, dying lawn outside.

At one time, people considered Lenny young at heart — drinking Scotch and playing cards late into the night with friends and family, and regularly prank calling his neighbors — but during this particular visit, Carl discovered his uncle to be anxious whenever someone outside on the street was heard walking by. Inexplicably, Lenny believed that these passing strangers are looking in, perhaps plotting to rob him. He watched television with a strongbox of his prized belongings on the couch cushion — as though it may wander off on its own, vanishing in the darkened house. He was like a sole passenger on a rapidly moving train, anxiously clinging to his seat, waiting for the last stop.

It soon became clear that Lenny — along with another 5.4 million Americans — was suffering from Alzheimer’s disease. As of today, no cure exists; what is available is treatment of symptoms at early stages — plus a number of misconceptions. Many readers may think Alzheimer’s is simply a natural part of getting older, but rather, the risk of getting the disease increases with age. Nor does it simply involve forgetfulness, the condition rather is a gradual neurodegenerative disease — one that accounts for up to 70 percent of cases of dementia every year, and one which gets progressively worse over time.

The Onset of Dementia

While dementia is hardly a new disorder, its causes are just beginning to be understood. Alzheimer’s is the most common and best-known disease that is thought to be hereditary in many cases. For that reason, Carl is taking no chances — aggressively following a diet and exercise regimen to stave off the disease’s onset, but remains hopeful that perhaps in his lifetime a cure could be found, or at least an effective way to delay the onset of Alzheimer’s most dreaded symptoms.

Since the disorder’s discovery by Alois Alzheimer in 1906, many neurologists suspect that the disease is the gradual result of “senile plaque” building up in the plasma membrane. The amyloid precursor protein contains a sequence known as amyloidbeta, which releases secretase enzymes throughout the brain, gradually dulling away parts of the organ used for navigation and thinking (such as the hippocampus and prefrontal cortex). The enzymes build up in a linear sequence, and this is why dementia is likely to advance with age.

Women tend to have more senile plaque buildup than men, and a correlation between buildup of plaque and Down syndrome has also been known to exist — this relation suggests that advanced treatments for Alzheimer’s may help with understanding a number of other genetic disorders. Bleeding from the fragile cerebral capillary has been known to coincide with the formation of plaque, giving the deposits the protein they need to thrive.

Another theory involves the buildup of neurofibrillary tangle — when faulty signaling in the brain causes the tau proteins, which make up neurons, to not connect properly but rather to overlap each other.

The exact cause has yet to be understood, and neuroscientists continue to debate whether or not these tangles in the brain are purely due to genetic factors, or whether physical injury (such as head trauma) may play at least a partial role in the faulty signaling, with long-delayed effects. Much controversy remains as to whether the tangles actually cause the onset of dementia or are just a byproduct of Alzheimer’s itself. Notably, buildup of aluminum in the brain is also suspected for causing these tangles.

Fragments: A Life With Dementia

Perhaps the most frustrating aspect of treatment is the moment when people discover that they have Alzheimer’s. Early detection of cancer may be relatively easy, for example, but the tricky quality of Alzheimer’s is that, after all, we all have bouts of forgetfulness — and the buildup of so-called senile plaque may in fact be an ordinary function of the brain. It’s just when the concentration reaches alarming levels that the symptoms become obvious. Meaning that people like Lenny could harbor the codes for Alzheimer’s for years before the right conditions set it off.

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